CME expires February 29, 2028

Go beyond traditional learning with a 360° perspective on orthopedic topics.

Each ICL360 is a cutting-edge CME course designed to provide a holistic learning experience, featuring curated video content sourced from expert-selected Instructional Course Lectures enhanced with insightful commentary and comprehensive assessment questions. This all-encompassing course goes beyond traditional learning by offering a complete 360° perspective on orthopedic topics. Explore additional resources, including full-text readings from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), technique videos from Orthopaedic Video Theater (OVT), and links to external literature and PubMed. Elevate your clinical decision-making skills and gain a well-rounded understanding of essential orthopedic concepts with ICL360.

This Instructional Course Lecture (ICL) highlights critical components of the preoperative evaluation, anesthetic considerations, and the use of perioperative oral and parenteral medications for total knee arthroplasty (TKA). The course underscores the transition from opioid-dependent monomodal analgesia to evidence-based multimodal pain management protocols designed to improve patient outcomes, early mobilization, and overall satisfaction. By integrating periarticular injections, advanced pharmacologic agents, and targeted therapy, these protocols minimize opioid use and its associated complications.

The preoperative evaluation, which explores the effect of a patient's opioid history on postoperative recovery and pain management strategies, is essential. The preoperative examination also reviews the role of pharmacogenetics in tailoring medication protocols, ensuring efficacy based on metabolic variations. Anesthetic considerations are discussed, detailing the comparative advantages and risks of regional versus general anesthesia and their influence on discharge readiness and postoperative complications.

The perioperative medication section explores contemporary options, including intravenous and oral analgesic agents, steroids, and ketamine, and reviews their efficacy, safety, and cost considerations. The course emphasizes minimizing opioid use via institutional prescribing guidelines, patient education, and monitoring programs to reduce the long-term risk of opioid dependency.

This Instructional Course Lecture provides a robust framework for orthopaedic surgeons aiming to refine their clinical practices in TKA, aligning with modern advancements and addressing the complexities of perioperative pain management.

Editor
Marlene DeMaio, MD EdD; FAAOS 

Learning Objectives

• Evaluate preoperative opioid use and its association with complications and outcomes after total knee arthroplasty.
• Integrate multimodal pain management protocols, including periarticular injections and oral/parenteral medications, to reduce opioid dependency and enhance patient satisfaction.
• Apply evidence-based pharmacologic guidelines to select appropriate preoperative and postoperative medications, including NSAIDs, gabapentinoids, and acetaminophen.
• Explain the role of genetic variations in medication metabolism and their effect on pain management efficacy in patients undergoing total knee arthroplasty.
• Differentiate between anesthetic approaches, including general and regional anesthesia, and their respective effects on postoperative pain and recovery.
• Assess the efficacy and safety profiles of adjunct medications, such as dexamethasone and ketamine, for pain reduction and management during the perioperative period.
• Implement strategies to minimize opioid prescription practices via institutional guidelines, patient education, and monitoring programs.
• Recognize factors that contribute to prolonged opioid use after total knee arthroplasty and establish systematic methods for addressing persistent pain.

Earn up to 5 AMA PRA Category 1 CME credits™.